Disease Management Update
Volume IV, No. 45
March 6, 2008

Dear Healthcare Intelligence Network Client,

Over 20 million Americans have diabetes, and only two-thirds are aware that they have the disease. Moreover, in 2005, 1.5 million new cases of diabetes were diagnosed in people 20 years of age or older. And in healthcare dollars, diabetes care was at $132 billion in 2002, where $92 billion was due to direct medical costs. The average medical costs for someone with diabetes 5.2 times greater than the cost for a person without diabetes, and 11 percent of national healthcare expenditures went to diabetes care.

This week's Disease Management Update looks at the impact diabetes can have on one's teeth, as well as a new training center launched by Johnson and Johnson to educate and train healthcare professionals in diabetes care and management.

Visit HIN's blog to read another study about diabetes.

Your colleague in the business of healthcare,
Laura M. Greene
Editor, Disease Management Update

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Table of Contents

  1. Diabetes and Gum Disease Keep Each Other Company
  2. Disease Management Q&A: Behavior Modification for Specific Diseases
  3. HealthSounds Podcast: Building a Diabetes Medical Home
  4. Diabetes Institute Launches Center to Provide Education and Training to Health Professionals
  5. Survey of the Month: Pain Management in Healthcare and the Workplace
  6. Changing Lives with Lifestyle Management

1. Diabetes and Gum Disease Keep Each Other Company

People with diabetes are at risk of losing their teeth, as serious gum disease (periodontal disease, not mere gingivitis) and diabetes tend to happen together. Periodontal disease is a gum infection that is a major cause of tooth loss in adults. Usually painless, it often goes undetected. Group Health and the Washington Dental Service (WDS) are teaming up on a new study to explore the relationship between diabetes and gum disease. The study is part of an ongoing partnership to strengthen the links between medical and dental care. Researchers will examine records from people age 40–74 who belong to both Group Health and WDS. They will see whether gum disease is linked to diabetes, blood sugar levels and other health problems and costs related to diabetes.

“Diabetics have a significantly higher risk of periodontal disease than non-diabetics,” noted Ron Inge, D.D.S., vice president and dental director for WDS. “Periodontitis may be a key contributor to complications of diabetes.”

To learn more about this analysis, please visit:

2. Disease Management Q&A: Behavior Modification for Specific Diseases

Each week, healthcare professionals respond to a reader's query on an industry issue. This week's experts are Richard Citrin, vice president of health and productivity at Corphealth Inc., Sean Sullivan, president and CEO of Institute for Health and Productivity Management, and Gregg Lehman, who was president and CEO of Gordian Health Solutions at the time of this interview and is currently president and CEO of HealthFitness.

Question: In the organizations that have been working on behavior modification, which diseases have you focused on and what was the criteria used in choosing these diseases?

Response: (Richard Citrin) For Corphealth there are two: depression and behavioral health disease management. But in our health coaching program, we don’t focus on a specific disease. We’re trying to identify sets of health behaviors that members engage in. This might be chronic disease management, which includes their interactions with the healthcare system and how well they communicate with their physician. For example, we look at health and lifestyle behaviors they engage in as well as stress emotions. We tend to focus on the bigger picture as opposed to looking at a specific disease process.

(Sean Sullivan): We’re finding, in talking to employers, that we need to organize things into a slightly larger picture for them. For example, if you think about pre-diabetics and diabetic risks, there are many connections to cardiovascular risks, hypertension, hyperlipidemia and of course to obesity, which is now the national rage. We are trying to organize that whole cluster into what we call “metabolic health” so we can think in larger terms about a diversity of factors that ultimately add up to healthy metabolism.

(Gregg Lehman): Many organizations are focusing on two categories of disease states: those that are low in frequency but high in costs, like end-stage renal disease, and those that are higher in frequency and moderate cost disease states, such as heart disease, diabetes and asthma. Many companies in the market are focused on the latter. The list of common conditions can include heart disease, diabetes, COPD, asthma, stroke, migraine, low back pain or other musculoskeletal problems. The market is evolving, and we’re being asked to add more competencies based on the prevalence of conditions identified not only from claims analysis but also as a result of stratification from the health risk assessments.

For more information on patient behavior modification, please visit:

We want to hear from you! Submit your question for Disease Management Q&A to info@hin.com.

3. HealthSounds Podcast: Building a Diabetes Medical Home

In this week's Disease Management podcast, Roberta Burgess, nurse case manager for Community Care Plan of Eastern North Carolina through Heritage Hospital in Tarboro, N.C., describes the contents of its provider toolkits and patient diabetes action plans, both key communication vehicles in its diabetes medical home project. She also details the duties of case managers, who form another vital link in the disease management chain that saved North Carolina $231 million in healthcare costs in 2005 and 2006.

To listen to this complimentary HIN podcast, please visit:

4. Diabetes Institute Launches Center to Provide Education and Training to Health Professionals

The Johnson & Johnson Diabetes Institute, LLC opened its first training center in the U.S. to improve how practitioners deliver diabetes care in local communities. The new facility, based in Silicon Valley, will provide comprehensive training each year for thousands of community-based nurses, physician assistants, diabetes educators and other health professionals using a curriculum developed with national diabetes organizations and academic centers. It addresses an acute shortage of skills training in diabetes management at the community level, which practitioners cite as one of the major obstacles to improving patient outcomes.

"At a time when the costs for diabetes in this country are estimated to be $174 billion annually, the nation needs new strategies to raise the level of care for people with diabetes, including stepped-up education and hands-on training of health professionals working at the local level," said former Acting U.S. Surgeon General, Kenneth P. Moritsugu, M.D., M.P.H., who now serves as the institute’s chairman. "Through this new training center, we will arm those on the front lines in delivering diabetes care with the latest information and practical skills so they can help their patients live healthier, longer lives."

To see more about this initiative, please visit:

5. Survey of the Month: Pain Management in Healthcare and the Workplace

Complete our online survey on health and wellness coaching by March 31, and you'll get a free executive summary of the compiled results.

To participate in this survey and receive its results, please visit:

6. Changing Lives with Lifestyle Management

Abandoning long-standing behaviors that are detrimental to one’s health is no simple feat, but it is necessary for an increasing number of people with life-threatening conditions such as diabetes, heart disease and obesity. This is why healthcare organizations are aiding such undertakings with lifestyle management (LM) programs. This executive summary provides the general character of more than 60 such initiatives, including the differing approaches and techniques in identification, treatment and outcome assessment.

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